This is just one small part of my daughter's presentation. If interest is shown I will offer more information. Physician: Make sure you understand how meds should be taken. Ask for samples meds, especially if it's a new medication for your loved one. Make sure the doctor is aware of who your "team" is-helpers, etc. Ask what signs/symptopms to be watching for (physical changes, behavioral changes) Clarify your responsibilities. Ask for available community resources, support. This is the time to QUESTION what you are unsure of, things that aren't "sitting right" with you.
YOU are the customer, and you are paying for the time you and your loved one are spending with the doctor and their expertise. If your questions aren't getting answered, ask again. Your time is as valuable to you as theirs is to them. Sometimes they get task oriented and need a gentle reminder of why you're there and why the visit is so important.
Yes....we need all the information you can provide us. One other thing about meds. a comment or two regarding what to do about meds. that the spouse has trouble swallowing because they are too big.
Today I had to have one of my dh's meds re-prescribed because he can't swallow them because of the size. The pill is a large 500 mg. pill and the dr. changed the prescribtion to 250mg...and taking two instead of the one large pill. Also, caregivers need to know that certain pills cannot be crushed or split because they are time-release. Also, information on how to add pills to pudding, applesauce, etc. I actually need some of this advice right now.
Nora, thanks for the information, please keep posting her presentation. Also, Judith brings up a good point on being able to swallow pills and having to have the meds represcribed (at an additional cost probably).
I would add be sure to take notes so you have something to remind you of what's been said As part of the discussion with the physician, I would ask how quickly can I get in touch with you if something changes due to he meds? I've found that psychiatrists in our area are difficult to reach after office hours and frequently do not reurn calls until they are back in the office (often 3-4 days afer the call)
For pill questions- which can be crushed, split, added to pudding, etc., your pharmacist might be able to give you better (and faster) information. They may also be able to give you some alternative ways (smaller pills, liquid, generics) to give the meds.
The ones we have that cannot be crushed are labeled on the bottle. Funny, a friend of mine who is a nurse told me they crush the "do not crush" ones when I was complaining to her about the size of Cipro!
DH takes Niaspan, which is enormous (to me, anyway) and it cannot be cut.
l think Joan's logging of meeting is suggestion is one of the best patient advocacy tools available for those who have placed their SO's.
I'm was a Reg Pharmacist long retired from the profession. caution many meds are extended or sustained release tablet form or are coated to protect the med from stomach acid. As Blue Daze said, check before splitting or crushing. Easy soluttion, Just about all meds are available in a liquid dose form
The Hospice dr. told me yesterday some of the meds are even available in a sprinkle form so you can easily sprinkle them on/in food and others liquid. Also, he told me which ones not to crush or split because they are time release and those are not good crush.
The tablet form of one of his meds is $10.21 for 60 doses. The gel form is NOT covered by insurance and 60 doses cost $349.99. The gel is applied when he won't take a pill. Luckily it does not have to be used often, so there were lots of doses left this month. Guess what? I just got the new med bill and 90 doses were ordered at a cost of $539. I'm going to ask about this on Monday, for sure! Needless to say, I'm just sick about this. The ALF is already $6K/month. And who knows how much longer his nightmare will go on? He can no longer use his walker because of balance issues, so he's taken to the dining room, etc. in a transport chair, which I was lucky enough to find at Walgreen's on sale for $99, as opposed to the $300 at the med supply store for the same chair. I'm getting so discouraged. Doesn't help that yesterday was our 9th wedding anniversary and he's unaware that he's married. However, he does know that I'm someone special who loves him.
Final note from Amy-The conference was a little bigger than I’d thought it would be, with people > from 15 states. There were a lot of family/caregivers there, and when I > consider my Mom and people like you, I believe that often they know more > about what’s going on than many professional/caregivers because they are so > personally invested. The fact that the family/caregivers were jotting down > notes was probably a pretty good sign!
PrisR My drug Plan is United Health Care via AARP and Meds are ordered from what was formerly Prescriptions Solutions/now Optima. I was denied coverage on a liquid dose form for DW and for myself generic vs brand name products (several opthalmic drops the preservative caused an allergic reaction swelling my eye shut). There is a very simple appeals process, with UHC at least, the MD simply has to write why he wants a brand name or other specific dose form, a I've yet to have the insurance company reject a request and while it may not be on the formulary I was able to obtain of coverage. i
Thanks, Marty. We both have a Humana policy and the ALF does not purchase through their Right Source program, but through a group that bubbles all the meds, as required by law in an ALF here in Florida. The local dispenser is right here in town and was also the provider for the previous ALF we just removed him from. It sure doesn't make sense to have a total of 150 doses delivered when only 3 have been used in the past month. I think that the prescribing docs have absolutely no knowledge or interest in what the costs are to the patient.
The talk Nora's daughter gave is so valuable for family caregivers. Some of us have experience advocating for a loved one, but many don't. My husband's dx came during my involvement with my parents' care, so I was already somewhat experienced. However, because his was a dementia dx and theirs wasn't, it was a completely different situation and I needed to be involved more intensively.
From my daughter-at yet another conference: Bitter is the last taste to go. Try pills in jam. Sweetest taste covers flavor best, texture works better than applesauce or pudding.
" We both have a Humana policy and the ALF does not purchase through their Right Source program, but through a group that bubbles all the meds, as required by law in an ALF here in Florida. "
As I investigate ALFs in my area, while they require that any pills that they disperse be in bubbles, they do not require that any meds be purchased through their pharmacies. They do offer to put the pills you buy in bubbles, either for free or a low cost.
Some info on bubble meds I learned the hard way. When DH was in an ALF they would only accept meds in a bubble pack and used their supplier. When I initially called our RX provider (CVS/Caremark) they advised me that they did not provide meds in a bubble pack and that I had to use the ALF's provider and submit bills as out of network to CVS/Caremark. I called again when I got the bill for the meds in a bubble pack and the cust svc person said I should have called, advised then the ALF would only accept bubble packs from their provider and request an exception or a waiver (not sure which) so that CVS/Caremark would cover the meds even thogh they were not ordered under their plan. If you get an answer you don't like the first time, call again or escalate. I didn't do that because we were in crisis but it does pay.
PaulC, DH's ALF wouldn't do anything for us regarding meds. We either had to find a supplier that would fill the RX in a bubble pack or use theirs. Each ALF is different.
LFL, I gathered that each ALF and NH is different. I just wanted to point that out. I don't know if it is a matter of local laws or customs. This was a big concern of mine about the future, that in addition to LTC costs I would have to pay substantially more for medication. I don't worry now but it might be a concern for others and it is something to ask when looking at LTC facilities.
And sometimes things happen so fast you don't have a choice.
Good point for others. Yes, we were in crisis and that's not the time to find out, I agree. And it never occurred to me (nor was it explained) that the pills would need to be in a bubble pack.
A few years ago, Steve's ALF told me meds would have to be in the bubble pack. When the economy went south, they dropped that requirement, as well as the initial community fee. They have more vacancies now and are actively marketing and making changes that make the facility more attractive to families. I think it pays to negotiate on issues like this and even on the monthly fees--you never know.